Free Instructions - New Hampshire

Instructions for completing Department Of Health And Human Services Or Agency Surrender Of Parental Rights
(NHJB-2081-FP) (RSA 170-B:5 through 170-B:12) Form use . If the Department of Health and Human Services, or a child-placing agency, has through court action or parental surrender been given care, custody and control of an adoptee, the department or agency must complete this form to surrender their rights to the adoptee. The form specifies the rights being surrendered and the continued legal relationship with the child until a final decree of adoption is issued. Top part of form ·COURT NAME: Enter the name of the county probate court where the document will be filed. (example: Belknap County Probate Court; Rockingham County Probate Court). ·CASE NAME: Enter the name of the birth name of the child to be adopted (example: DHH or Agency Surrender of Parental Rights over Susan Ann Jones or John Adams). ·CASE NUMBER: Leave blank if not yet assigned by court OR fill in case number if it is known. Numbered part of form 1. Name of agency surrendering rights is the name of the agency filing this petition. Enter the name of the Executive head or authorized representative, telephone number, email address and complete mailing address with zip code. Child Name is the birth name of the child. Enter the full birth name of the child and the child's Date of Birth and Place of Birth, which is the city and state or country where the child was born. Enter the Name of the birth mother. Enter the Date of birth mother's surrender or termination of parental rights (TPR). Enter the Place of surrender or TPR and the Case number. Enter the Name of birth father. Enter the Date of birth father's surrender or termination of parental rights (TPR). Enter the Place of surrender or TPR and the Case number.

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Signature section Please Read Carefully the paragraphs that are prior to the signature line. This form must be signed in the presence of a Notary Public or Justice of the Peace. They will complete the section immediately following your signature. You will sign the form on the Signature of Executive Head or Authorized Representative line, and date it in the appropriate space to the left. Order This section will be completed by the judge once the document is filed with the court and reviewed in detail by the judge.

Review the completed form for accuracy prior to filing it with the court. If completing this form on-line, some fields may be filled in automatically based on entries in other fields. If more space is needed for any question, please attach additional sheets of paper.
NHJB-2081-FP Instructions (06/26/2007) Page 1 of 1